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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002158
Report Date: 03/19/2024
Date Signed: 03/19/2024 12:31:35 PM

Document Has Been Signed on 03/19/2024 12:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BRIGHT HORIZONS UCSF MARILYN REED LUCIA CDCFACILITY NUMBER:
384002158
ADMINISTRATOR:CAYAGO, JENALINEFACILITY TYPE:
830
ADDRESS:610 PARNASSUS AVENUETELEPHONE:
(415) 504-7023
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94143
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 18DATE:
03/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Jenaline CayagoTIME COMPLETED:
01:00 PM
NARRATIVE
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On March 19, 2024, at approximately 11:45am, Licensing Program Analyst (LPA) Ly conducted a Case Management Inspection at the facility due to a self reported incident. During today's visit, LPA met with facility Center Director Jenaline Cayago. There were 18 children and 8 staff including the Center Director present during today's visit.

During today's visit, LPA interviewed Center Director regarding the self reported Unusual Incident Report happened on 03/08/2024. Based on interview collected during today's visit, self reported phone call to the Regional Office and LIC 624 Unusual Incident Report, a child was left in the playground as the group was transitioning into the classroom. Child was left for an approximate 30 seconds-1 minute. Child was found by another group that was transitioning out into the playground for outdoor play.

Based on interview and information collected, facility violated the Care and Supervision Regulation. Since incident, involved staff was placed on Administrative Leave. Per Facility Memo collected on this day, staff has returned to facility. Prior to returning into classroom, staff had a meeting with Center Director reviewing safety protocols and supervision of children (indoor and outdoor) policy.

Self Reported of child was left unattended in the playground poses a potential health and safety risk to children in care. Type B deficiency is being cited today in accordance with with the California Code of Regulations, Title 22, see LIC 809D.

Plans of Corrections (POC) were developed and reviewed with Director. A copy of this report and appeal rights were discussed and left with Director whose signature on this form confirm receipt of reports. Notice of Site Visit was provided to Director. Director was advised Notice of Site Visit to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/19/2024 12:31 PM - It Cannot Be Edited


Created By: Winnie Ly On 03/19/2024 at 12:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BRIGHT HORIZONS UCSF MARILYN REED LUCIA CDC
FACILITY NUMBER: 384002158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/02/2024
Section Cited
CCR
101229(a)(1)

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101229(a)(1) Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).
This requirement was not met as evidence:
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Center Director submitted proof of meeting with involved staff. Safety protocols and supervision of children (indoor and outdoor) policy have been reviewed with staff prior to having staff return to the classroom.
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Based on self reported incident reported to Licensing on 03/08/2024, child was left unattended in the playground poses a potential health and safety risks to persons in care.
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Citation is cleared during today's visit.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Garfield Leung
LICENSING EVALUATOR NAME:Winnie Ly
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2024


LIC809 (FAS) - (06/04)
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